Psychopathic traits in a representative sample of Finnish male prisoners.

BACKGROUND: The psychopathic traits measured with the Hare Psychopathy Checklist-Revised (PCL-R) in a representative national prisoner sample have not been studied in Finland before. It has been unclear whether there could occur some national differences or whether the PCL-R can be used for assessing psychopathic traits in the Finnish forensic settings. AIMS: Our aim was to study the distribution of psychopathic traits in the Finnish male prisoners as well as the correlations of these traits with DSM-IV disorders and to compare the sample with similar samples of Europe and America. METHODS: 171 male prisoners representing all Finnish sentenced male offenders (about 3300) were studied using the PCL-R, SCID-I and SCID-II. RESULTS: The results of the first Finnish study utilizing the PCL-R in a representative national sample of male prisoners were quite similar to the findings of the previous studies of male prisoners carried out in North America, the UK and Sweden. The scores of the interpersonal facet are lower in this sample than in the sample of North America. In total, 16.4% of the Finnish male prisoners can be diagnosed as having a psychopathic disorder. CONCLUSIONS: The PCL-R is a reliable and valid measure of the psychopathy construct of the Finnish male prisoners. The PCL-R is applicable to the Finnish offenders and it is a useful tool for assessing psychopathy in the Finnish criminal justice settings.

Finnish female prisoners - heavy consumers of health services.

AIMS: Previous prison studies show that female prisoners often have more health problems than male prisoners do and that they have many chronic health conditions. Few studies have been made among offenders concerning the use of health services, and even fewer concerning physical diseases. We studied the self-reported lifetime somatic diseases, the use of health services and the current use of prescription medicines among Finnish female prisoners and compared them with males. METHODS: The sample consisted of 101 females and 309 male prisoners as controls. The study included several questionnaires and interviews conducted by experienced prison nurses. RESULTS: The women had more commonly genitourinary, virus hepatitis/HIV infections and group "other diseases" than the men. Over 80% of the women and men have had accidents/injuries. Four out of five women, and half of the men, used some medicine regularly. Of the females, 92% (80% of the males) reported lifetime hospital care and 65% (61%) treatment in surgery department, respectively; 70% of the females (53% of the males) reported lifetime use of any psychiatric service; 66% of the women (46% of the men) had received psychiatric out-patient services, and 43% (31%) psychiatric in-patient hospital care and 38% (30%) substance abuse services, respectively. CONCLUSIONS: The heavy use of health services among female prisoners resulted mainly from the use of services for substance use and other mental disorders and treatment in surgery department. Compared to men, the difference in using health services was associated with psychiatric services.

The changing picture of substance abuse problems among Finnish prisoners.

PURPOSE: Marginalized people are often absent from population surveys of substance use and from research based on care data. Special methods are needed to reach these small but very significant groups. This study analyses how patterns of intoxicant use have changed over time among one of the most marginalized group of people, the prisoners. METHODS: Nationally representative samples of Finnish prisoners were examined: 903 prisoners in 1985, 325 prisoners in 1992, and 410 prisoners in 2006. Comprehensive field studies consisting of interviews and a clinical medical examination were used. RESULTS: In 1985, a diagnosis for alcoholism was given to 41% of the men and 36% of the women prisoners. An increase over time was observed, and in 2006, 52% of men and 51% of women prisoners were alcohol dependent. Dependence on a drug was diagnosed in 6% of men and 3% of women in 1985; this prevalence had increased to 58% of men and 60% of women in 2006. CONCLUSIONS: A dramatic change in prevalence of illegal drug use and drug addiction among prisoners has taken place in the past 20 years. Recognizing this shift from alcohol to other intoxicants is important since drugs are illegal substances and thus tend to lead to involvement with the judicial sector, thus stigmatizing and deepening the spiral of marginalization.

Drug use among prisoners: by any definition, it's a big problem.

According to several studies, the prevalence of drug use (1) among prisoners is manyfold compared to general population. However, comparisons across studies are hampered by the use of a variety of mutually noncomparable methodologies. We report substance use among Finnish prisoners using three methods and analyze these differences. The material consisted of 610 Finnish prisoners in 2006 and represents all Finnish prisoners. The subjects participated in a comprehensive field study including a standardized psychiatric interview (SCID-I). Alcohol abuse/dependence was diagnosed in 68% (SCID-I) and 72% (ICD-10) among men and 70% (both SCID-I and ICD-10) among women. Drug abuse/dependence was diagnosed in 62% (SCID-I) and 69% (ICD-10) among men and 64% (SCID-I) and 70% (ICD-10) among women prisoners. Interview data revealed that the majority had at least tried most substances. Both alcohol and drug abuse/dependence were vastly more common among Finnish prisoners than reported elsewhere. The DSM-IV-based SCID-I produced slightly lower prevalence estimates than an ICD-10 clinical examination, but overall SCID/ICD agreement was very good. It seems that physicians use information other than that captured by standardized structured clinical interview when placing a diagnosis. Nonclinical interview-based prevalence figures may overestimate harmful use of drugs unless known risk patterns of use (e.g., intravenous use) are specifically addressed.

Mania in the Nordic countries: patients and treatment in the acute phase of the EMBLEM study.

In bipolar disorder, mood stabilizers and second-generation antipsychotics have a central role in pharmacotherapy. There are, however, substantial differences in how the treatment is realized in different countries. The aim of this paper was to compare the treatment of acute mania in the Nordic countries with other European countries during the first 12 weeks of the EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) study. Adult patients with bipolar disorder were enrolled within standard course of care as in/outpatients if they initiated/changed oral medication with antipsychotics, anticonvulsants or lithium for treatment of acute mania. Five hundred and thirty European psychiatrists including 23 Nordic psychiatrists enrolled 3459 patients including 79 Nordic patients eligible for analysis using the same study methods assessing demographics, psychiatric history, clinical status, functional status and pharmacological treatment. Psychiatric status at inclusion measured by the Young Mania Rating Scale (YMRS) and the Clinical Global Impression-Bipolar Disorder (CGI-BP) were similar in the Nordic and European patient groups, which is surprising as 73% of the Nordic patients compared with 38% of the European patients were inpatients. In the Nordic group of patients, more patients were living independently. Before inclusion in the study more patients in the Nordic group had combination therapy, but after inclusion in the study the prescription pattern of psychopharmacy was similar in the Nordic and the European patient groups. This study indicated differences in admission patterns, patient social functioning and medical treatment in the Nordic patients compared with the European patients.

Work ability and treatment needs among Finnish female prisoners.

PURPOSE: The purpose of this paper is to assess the work ability and employment history of Finnish female prisoners and their need for treatment. DESIGN/METHODOLOGY/APPROACH: The sample consisted of 101 female prisoners, with 309 male prisoners for comparison. The methods included interviews, the Structured Clinical Interview for DSM-IV Axis I, II Disorders and medical examination including ICD-10 diagnoses. FINDINGS: Among women, 78 per cent were unemployed and only 6 percent were employed whereas among men, the proportion of those employed was four times greater than for women. Of women, 42 per cent were unable to work; of men 11 per cent. Substance abuse disorders were the most common reason for impaired work ability (over 70 per cent in both genders). Among women, other mental disorders were the second most common reason (39 per cent), somatic diseases caused impairment in 23 per cent. Basic socio-demographic factors were not associated with impaired work ability among women. Violent crime as the present main offence was significantly more common among prisoners with limited working capacity. Need for treatment was found in 94 per cent of women and 90 per cent of men. In both genders, the majority of treatment needs were for mental disorders. Finnish female prisoners have serious problems with substance abuse, of both alcohol and drugs, which impairs their work ability, employability and is the cause of their need for treatment. In addition, female prisoners have other mental disorders commonly complicating their situation. ORIGINALITY/VALUE: This paper is a part of the first comprehensive health study of Finnish female prisoners.

Childhood maltreatment and mental disorders among Finnish prisoners.

PURPOSE: In a health survey of Finnish prisoners in 2006, the authors aimed to study frequency and gender differences in childhood physical and sexual abuse, and the connections of maltreatment in childhood to substance abuse and mental health among female and male prisoners. DESIGN/METHODOLOGY/APPROACH: The sample consisted of 101 female prisoners, with 309 male prisoners for comparison. The subjects participated in a comprehensive field study consisting of several questionnaires, interviews, the Structured Clinical Interview for DSM-IV Axis I and II Disorders (SCID I, II) and a clinical medical examination including ICD-10 diagnoses. FINDINGS: Both forms of abuse were more common among females than males (childhood physical abuse 25 per cent versus 15 per cent and childhood sexual abuse 32 per cent versus 7 per cent). Associations of childhood abuse with substance abuse and mental health were different among males and females. Family integrity was important only for males and in connection with drug dependence and antisocial personality disorder. The gender differences did not concur with those reported in studies on general populations. ORIGINALITY/VALUE: This is a part of the first comprehensive health survey of Finnish prisoners.